Q&A: Missing — a global system for pandemics, says IFRC's Chapagain

“Baffling”: That’s the word Jagan Chapagain, secretary-general of the International Federation of Red Cross and Red Crescent Societies, used to describe the lack of a global system amid COVID-19.

“I still cannot comprehend that in a situation like this, we don't have one global system,” he told Devex. “[In the] European Union, you have one vaccine here, one COVID tool here, you have another in a neighboring country with [an] almost open border. ... This vaccine is approved in France, but not approved in Germany, approved in Switzerland, but not approved [elsewhere]. I mean, how is that possible?”

Chapagain — who said it’s been an intense but extremely fulfilling 18 months since he took on the role of secretary-general in early 2020 — hopes discussions around a potential international treaty for pandemic preparedness and response could lead to a global system going forward.

In March, various world leaders voiced their support for such a treaty, stating that the goal would be “to foster an all-of-government and all-of-society approach” to future pandemics, which would include various alert systems, sharing of data, and the production and distribution of medical supplies at local and international levels.

Speaking to Devex, Chapagain explained how the absence of a united approach has affected vaccine equity, how the COVAX Humanitarian Buffer could help, and why investment in local capacity building is key to moving forward.

This conversation has been edited for length and clarity.

IFRC recently highlighted vaccine equity as being the key to reducing the likelihood of other COVID-19 variants to emerge and ending the pandemic. What are the biggest challenges around vaccine equity you’re seeing?

On the equity part … I think the pressure [and] probably the politics of the countries [meant] everybody wanted to get the vaccine out themselves first. When you have this conversation bilaterally with many leaders they fully understand that this, in many ways, [was] a short-sighted policy. Vaccinating people in my country or my city actually doesn't protect me.

I think when you have a bilateral conversation, there is a good understanding and appreciation, but what with the level of the politics and the division we see in many countries, leaders probably felt pressurized to frankly hold the vaccine in many of the developed world. And that has, of course, created that inequity between the haves and have nots, if I can use that word.

Then there’s a secondary inequity … Even [in] the countries which have received the vaccine, there are inequities on the basis of the cities versus the rural areas, the people with the access versus the ordinary people. [In] some countries, I hear that even if the vaccine comes, it’s not delivered on the basis of the priority needs but on the basis of who knows whom.

The second aspect is really not thinking through that even when the vaccine is available, getting the vaccine actually in the arms of the people [involves] massive logistics. In a way getting the vaccine on the tarmac of the airport in the capital is relatively easy, but getting from the tarmac to the arms of the people was not fully appreciated. It’s still not fully appreciated in many countries … South Sudan basically had around 60,000 of the vaccines wasted. The vaccine [doses] came, but they were not quite ready to distribute them … In India, it was like 4.5 million doses.

How might the COVAX Humanitarian Buffer, a mechanism within COVAX designed to provide up to 5% of COVAX’s real-time doses to high-risk and vulnerable populations in humanitarian settings, help to tackle inequity?

COVAX has been relatively well-funded recently, but they still need more funding. So, within that, then we need to fund that humanitarian buffer and IFRC is one of the organizations who can use vaccines from the buffer.

The first thing is getting those 100 million vaccines. So much demand still exists. Then the second thing is, of course, getting those vaccines to those last-mile communities and that's quite a challenge in a number of countries for various reasons … So that's why the humanitarian buffer is a great idea and I think this can definitely help to reach some of those last-mile and difficult communities, marginalized groups, the migrant communities … But at the same time, if it’s not done in coordination with local health authorities — so that the host communities are actually getting it at the same time — it creates a problem.

Of course, these are different instruments. COVAX is there, the buffer is there, and there is a bilateral collaboration happening. Countries are planning their own vaccines. But it has to be part of one national vaccine strategy rather than multiple different pockets of vaccine mobilization.

There is currently an issue of a lack of legal liability within the COVAX Humanitarian Buffer. Are you expecting things to be sorted out fairly quickly?

That continues to be the issue. And again, in a situation like this, we thought some of these things would be resolved more easily. There could be more understanding both from the government but also from the suppliers. I think sometimes we don't see that everybody is looking for legal protection.

Once the buffer is ready to go, is IFRC ready to support in administering the vaccines?

In many countries, we’re already doing that … We don't want to compete with what the World Health Organization is doing on the normative side. We don't want to compete with what COVAX is trying to do so we’ve designed our strategy to be complementary to existing systems.

As part of that complementarity, our first priority has always been to facilitate the vaccination rather than do the vaccination by ourselves because other organizations and the government are much better placed to do that. Facilitates means working around the vaccine hesitancy, working around social mobilization, community mobilization, supporting the health structures in many of the developing countries. But in a number of countries, we’re actually also supporting our local Red Cross [and] Red Crescent branches to carry out the vaccinations.

Throughout this pandemic, are there any lessons IFRC has learned that you think put the organization in good stead going forward?

I'm a bit hesitant to say these are the lessons we’ve learned because I feel like we think we learn something and every month something new comes … but there are a few things at the high level.

The lack of global preparedness is one big lesson learned and I think this is something we want to keep for the future, not to be complacent.

The second one — that is beyond IFRC — is the disparity that exists between countries and within countries. If you talk to some countries, you go to the capital, the capacity is at a level, then you just drive 100 kilometers, and [there's an] absolute lack of investment in the public health system, public health infrastructure, and the human resources required. If you have a good public health system, that’s good for every situation. You don't need to prepare separately for COVID-19 … It made it so obvious that the public health systems have been so under-resourced, including in the developed world.

[A] very important lesson learned — and this is something we have been talking about — is the value of the local capacity. When disasters happen, we’re so quick to mobilize people from all over the world. I remember when the Nepal earthquake happened … within one week we had 330 expats flying into Kathmandu to help. Now, without 330 expats, we have to deliver. The interesting thing is we could deliver … I think we will invest much more on that local capacity moving forward.

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